Substance Use in Adolescence
If you need help now
In an emergency — someone unresponsive, struggling to breathe, or having a seizure — call 911.
SAMHSA National Helpline: 1-800-662-4357. Free, confidential, 24 hours a day, in English and Spanish. Treatment referral and information.
988 Suicide & Crisis Lifeline — call or text, 24 hours a day.
Naloxone reverses opioid overdose and is available without a prescription in every US state. If opioid use is a possibility in your household, ask a pharmacist or your doctor about obtaining it and how to use it. Many families keep it for the same reason they keep a first aid kit.
Substance use in adolescence is common, and most young people who try something do not go on to develop a substance use disorder. Risk is not evenly distributed, though, and some of what raises it is specific and addressable. Adolescents with ADHD have consistently higher rates of substance use, and the risk appears highest where the ADHD is unrecognized or unsupported — which points toward one of the more useful things a family can do. Autistic teenagers are less likely to use substances socially and more likely to use them to manage anxiety, sensory overload, or the exhaustion of masking. The response that works best is rarely the one that comes naturally: staying in the conversation matters more than winning it.
Why neurodivergent teens are at higher risk
Generic advice about teenagers and drugs is everywhere, and this page is not that. What is worth saying here is narrower and more useful: risk is not evenly distributed, and the part that is concentrated in neurodivergent adolescents has reasons that a family can act on.
Does untreated ADHD increase substance use risk?
Adolescents with ADHD have consistently higher rates of substance use, and the pattern in the research points toward risk being highest where the ADHD is unrecognized or unsupported. That reframes what a family can do about it — identification is not a separate issue from prevention.
Several mechanisms are proposed: impulsivity and reduced weighing of consequences; use as self-medication for attention, restlessness, or sleep; social difficulty and the wish to fit in; and the accumulated effect of years of struggling and being told to try harder.
Why do autistic teenagers use substances differently?
Because the reason is usually not social. Autistic teenagers are generally less likely to use substances socially — but where use does occur, it is more often to manage anxiety, sensory overwhelm, or the exhaustion of masking.
That changes what helps. Support aimed at peer pressure and refusal skills misses it entirely. Support aimed at sensory load, anxiety, and reducing the need to mask addresses the thing the use is doing. → Autistic burnout · Sensory processing and autism
Anxiety and depression are both associated with substance use in adolescence, and both are treatable. Untreated mental health difficulty is one of the more modifiable risk factors available. → Behavior and emotions
What the adolescent brain has to do with it
Adolescence involves a genuine mismatch in timing: the systems driving reward-seeking and social motivation mature earlier than the systems supporting deliberation and impulse control. That gap is normal development, not a defect, and it closes.
It does mean that a teenager weighing a decision is not doing the same arithmetic an adult would, particularly in company and particularly when tired. Arguing harder does not change the arithmetic. Changing the situation sometimes does.
Signs worth paying attention to
No single sign means anything on its own. Patterns and changes are what matter.
- Behavior: a marked shift in friendship group; secrecy beyond ordinary teenage privacy; losing interest in things that mattered to them; sleep pattern changes; unexplained money or missing items
- Functioning: school attendance or grades dropping; giving up activities; withdrawing from family
- Physical: changes in appetite or weight; red eyes; unexplained smells; coordination or speech that seems off; frequent illness
- Emotional: irritability beyond the usual; mood swings; defensiveness about specific topics
How to respond
Choose the moment. Not during an argument, not while they are intoxicated, not in front of siblings. Side by side — driving, walking — is easier than face to face.
Lead with concern, not accusation. "I've noticed you seem different lately and I'm worried about you" opens a conversation. "Have you been using drugs?" closes one.
Listen more than you talk. The goal of the first conversation is a second conversation.
Ask what it does for them. A teenager using to manage anxiety, sleep, or sensory overload is telling you something important. That is information, not an excuse.
Do not threaten what you will not do.
Stay connected. The strongest protective factor across the research is a young person feeling connected to at least one adult who is consistently there.
What should I say?
Say what you have noticed and that you are worried, and then stop talking. Concrete and non-accusatory beats general and interrogative: "you've seemed flat for a few weeks and you're not seeing your friends" gives them something to respond to.
What makes a teenager stop talking to you?
Reacting with anger or panic, and punishing the disclosure itself. A young person who tells you something and is punished for telling you has learned exactly one thing from it.
Also: telling other people without asking; making it about you and how it reflects on the family; and ultimatums that cannot be enforced.
What treatment involves
Named at category level. This is not treatment guidance, and it is not a substitute for assessment.
Assessment first, by a professional experienced with adolescents — because what is underneath matters as much as the use itself.
Psychological approaches with evidence in adolescents include family-based therapy, cognitive behavioral approaches, and motivational interviewing.
Treating co-occurring conditions. ADHD, anxiety, depression, and trauma all need addressing alongside rather than afterwards. Treating the substance use alone tends not to hold.
Medication may form part of treatment for some substances, and that is a medical conversation.
Levels of care range from outpatient through to residential, matched to severity.
What reduces risk
- Getting ADHD, autism, anxiety, and depression identified and supported. This is the one this page exists to make.
- One consistently present adult. The most robust protective factor there is.
- Something they are good at, and somewhere they belong
- Sleep, which is both a risk factor and a symptom
- Conversations that happen before there is a problem, and more than once
Where to get help
Your pediatrician can assess and refer, and is usually the least intimidating starting point.
SAMHSA National Helpline: 1-800-662-4357 — free, confidential, 24 hours a day, for treatment referral and information.
988 Suicide & Crisis Lifeline — call or text, 24 hours a day.
Frequently asked questions
Are teenagers with ADHD more likely to use substances?
Rates are consistently higher, and the risk appears greatest where ADHD is unrecognized or unsupported. Getting ADHD identified and supported is one of the more useful preventive steps available.
My autistic teen is using substances. Is that different?
Often yes. Autistic young people are less likely to use socially and more likely to use to manage anxiety, sensory overload, or the exhaustion of masking — which means support aimed at social pressure misses the point.
What should I say?
Lead with concern rather than accusation, choose a calm moment, and listen more than you talk. The aim of the first conversation is that there's a second one.
Does trying something mean addiction?
No. Most young people who try a substance don't develop a substance use disorder. Frequency, escalation, and whether it's being used to cope are what matter.
Should I search their room?
There's no single right answer, and it depends on your concern level and your relationship. Weigh what you'd gain against what it may cost in trust — and consider talking to a professional before deciding.
Where do I start?
Your pediatrician can assess and refer. The SAMHSA National Helpline — 1-800-662-4357 — is free, confidential, and available 24 hours a day for treatment referral.
Can this be treated?
Yes. Adolescent substance use disorders are treatable, and outcomes are better when co-occurring conditions are treated alongside and families are involved.
Disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It has not had clinical review. In an emergency call 911. SAMHSA National Helpline: 1-800-662-4357.